tbuckley/cabot-search huggingface dataset:
Impact of guideline recommendation for novel surgical procedures on surgeons’ decisions: a time series analysis of gastric cancer surgeries from a nationwide cohort study
Authors: Michitaka Honda, Hideo Yasunaga, Nobuaki Michihata, Teppei Miyakawa, Ryosuke Kumazawa, Hiroki Matsui, Takahiro Imaizumi
Journal: International Journal of Surgery (2023)

Since two Japanese guidelines, for gastric cancer treatment and for minimally invasive surgery, were simultaneously revised in 2014, laparoscopic distal gastrectomy has been a standard procedure for clinical stage I gastric cancer.We evaluated the impact of this revision on surgeons' decision-making using a nationwide inpatient database in Japan. We described the time trends in the proportion of laparoscopic surgery from January 2011 to December 2018. We performed an interrupted time series analysis; the exposure time point was August 2014, and the main outcome was the change in slope before and after the revision of the guidelines. We performed a subgroup analysis of hospital volume and the odds ratio (OR) for postoperative complications according to exposure.A total of 64 910 patients who underwent subtotal gastrectomy for stage I disease were identified. During the study period, the proportion of laparoscopic surgery showed a consistent increase from 47.4 to 81.2%. After the revision, the slope of the increase was rather slow; the OR [95% CI] was 0.601 [0.548-0.654] before the revision and 0.219 [0.176-0.260] after the revision. The adjusted ORs were 0.642 [0.575-0.709] before the revision and 0.240 [0.187-0.294] after the revision.The revision of the guidelines recommending laparoscopic surgery had little impact on surgeons' decisions regarding the choice of procedure.
Diagnostic pathways to wild‐type transthyretin amyloid cardiomyopathy: a multicentre network study
Authors: Giacomo Tini, Paolo Milani, Mattia Zampieri, Angelo G. Caponetti, Francesca Fabris, Andrea Foli, Alessia Argirò, Carlotta Mazzoni, Christian Gagliardi, Simone Longhi, Giulia Saturi, Giuseppe Vergaro, Alberto Aimo, Domitilla Russo, Guerino G. Varrà, Matteo Serenelli, Gioele Fabbri, Laura De Michieli, Giuseppe Palmiero, Giuseppe Ciliberti, Samuela Carigi, Eugenio Sessarego, Giulia E. Mandoli, Giulia Ricci Lucchi, Valeria Rella, Enrico Monti, Elisa Gardini, Michela Bartolotti, Lia Crotti, Elisa Merli, Roberta Mussinelli, Pier Filippo Vianello, Matteo Cameli, Francesca Marzo, Federico Guerra, Giuseppe Limongelli, Alberto Cipriani, Stefano Perlini, Laura Obici, Federico Perfetto, Camillo Autore, Italo Porto, Claudio Rapezzi, Gianfranco Sinagra, Marco Merlo, Beatrice Musumeci, Michele Emdin, Elena Biagini, Francesco Cappelli, Giovanni Palladini, Marco Canepa
Journal: European Journal of Heart Failure (2023)

Epidemiology of wild-type transthyretin cardiac amyloidosis (ATTRwt-CA) remains poorly defined. A better characterization of pathways leading to ATTRwt-CA diagnosis is of key importance, and potentially informative of disease course and prognosis. The aim of this study was to describe the characteristics of contemporary pathways leading to ATTRwt-CA diagnosis, and their potential association with survival.This was a retrospective study of patients diagnosed with ATTRwt-CA at 17 Italian referral centres for CA. Patients were categorized into different 'pathways' according to the medical reason that triggered the diagnosis of ATTRwt-CA (hypertrophic cardiomyopathy [HCM] pathway, heart failure [HF] pathway, incidental imaging or incidental clinical pathway). Prognosis was investigated with all-cause mortality as endpoint. Overall, 1281 ATTRwt-CA patients were included in the study. The diagnostic pathway leading to ATTRwt-CA diagnosis was HCM in 7% of patients, HF in 51%, incidental imaging in 23%, incidental clinical in 19%. Patients in the HF pathway, as compared to the others, were older and had a greater prevalence of New York Heart Association (NYHA) class III-IV and chronic kidney disease. Survival was significantly worse in the HF versus other pathways, but similar among the three others. In multivariate model, older age at diagnosis, NYHA class III-IV and some comorbidities but not the HF pathway were independently associated with worse survival.Half of contemporary ATTRwt-CA diagnoses occur in a HF setting. These patients had worse clinical profile and outcome than those diagnosed either due to suspected HCM or incidentally, although prognosis remained primarily related to age, NYHA functional class and comorbidities rather than the diagnostic pathway itself.
Superiority of low‐dose benzbromarone to low‐dose febuxostat in gout patients with renal uric acid underexcretion: comment on the article by Yan et al
Authors: Tomoyuki Kawada
Journal: Arthritis & Rheumatology (2023)

Disclosure Form Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
Impacts of ischemic preconditioning in liver resection: systematic review with meta-analysis
Authors: Glauber C. de Oliveira, Walmar K. de Oliveira, Winston B. Yoshida, Marcone L. Sobreira
Journal: International Journal of Surgery (2023)

Objective: To assess the beneficial effects of ischemic preconditioning (IPC) in liver resection and evaluate its applicability in clinical practice. Summary Background Data: Liver surgeries are usually associated with intentional transient ischemia for hemostatic control. IPC is a surgical step that intends to reduce the effects of ischemia–reperfusion; however, there is no strong evidence about the real impact of the IPC, and it is necessary to effectively clarify what its effects are. Methods: Randomized clinical trials were selected, comparing IPC with no preconditioning in patients undergoing liver resection. Data were extracted by three independent researchers according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, Supplemental Digital Content 1, http://links.lww.com/JS9/A79. Several outcomes were evaluated, including postoperative peaks of transaminases and bilirubin, mortality, length of hospital stay, length of stay in the ICU, bleeding, and transfusion of blood products, among others. Bias risks were assessed using the Cochrane collaboration tool. Results: Seventeen articles were selected, with a total of 1052 patients. IPC did not change the surgical time of the liver resections while these patients bled less (Mean Difference: −49.97 ml; 95% CI: −86.32 to −13.6; I 2 : 64%), needed less blood products [relative risk (RR): 0.71; 95% CI: 0.53–0.96; I 2 =0%], and had a lower risk of postoperative ascites (RR: 0.40; 95% CI: 0.17–0.93; I 2 =0%). The other outcomes had no statistical differences or could not have their meta-analyses conducted due to high heterogeneity. Conclusions: IPC is applicable in clinical practice, and it has some beneficial effects. However, there is not enough evidence to encourage its routine use.
Comparison of Perinatal Outcomes for Women With and Without Epilepsy
Authors: Paolo Pierino Mazzone, Kirsty Mhairi Hogg, Christopher J. Weir, Jacqueline Stephen, Sohinee Bhattacharya, Richard F. M. Chin
Journal: JAMA Neurology (2023)

Importance Pregnant women who have epilepsy need adequate engagement, information, and pregnancy planning and management to improve pregnancy outcomes. Objective To investigate perinatal outcomes in women with epilepsy compared with women without epilepsy. Data Sources Ovid MEDLINE, Embase, CINAHL, and PsycINFO were searched with no language or date restrictions (database inception through December 6, 2022). Searches also included OpenGrey and Google Scholar and manual searching in journals and reference lists of included studies. Study Selection All observational studies comparing women with and without epilepsy were included. Data Extraction and Synthesis The PRISMA checklist was used for abstracting data and the Newcastle-Ottawa Scale for risk-of-bias assessment. Data extraction and risk-of-bias assessment were done independently by 2 authors with mediation conducted independently by a third author. Pooled unadjusted odds ratios (OR) or mean differences were reported with 95% CI from random-effects ( I 2 heterogeneity statistic &amp;amp;gt;50%) or fixed-effects ( I 2 &amp;amp;lt; 50%) meta-analyses. Main Outcomes and Measures Maternal, fetal, and neonatal complications. Results Of 8313 articles identified, 76 were included in the meta-analyses. Women with epilepsy had increased odds of miscarriage (12 articles, 25 478 pregnancies; OR, 1.62; 95% CI, 1.15-2.29), stillbirth (20 articles, 28 134 229 pregnancies; OR, 1.37; 95% CI, 1.29-1.47), preterm birth (37 articles, 29 268 866 pregnancies; OR, 1.41; 95% CI, 1.32-1.51) and maternal death (4 articles, 23 288 083 pregnancies; OR, 5.00; 95% CI, 1.38-18.04). Neonates born to women with epilepsy had increased odds of congenital conditions (29 articles, 24 238 334 pregnancies; OR, 1.88; 95% CI, 1.66-2.12), neonatal intensive care unit admission (8 articles, 1 204 428 pregnancies; OR, 1.99; 95% CI, 1.58-2.51), and neonatal or infant death (13 articles, 1 426 692 pregnancies; OR, 1.87; 95% CI, 1.56-2.24). The increased odds of poor outcomes was increased with greater use of antiseizure medication. Conclusions and Relevance This systematic review and meta-analysis found that women with epilepsy have worse perinatal outcomes compared with women without epilepsy. Women with epilepsy should receive pregnancy counseling from an epilepsy specialist who can also optimize their antiseizure medication regimen before and during pregnancy.
Textbook outcome as a composite outcome measure in laparoscopic pancreaticoduodenectomy: a multicenter retrospective cohort study
Authors: Yi Wu, Bing Peng, Jianhua Liu, Xinmin Yin, Zhijian Tan, Rong Liu, Defei Hong, Wenxing Zhao, Heshui Wu, Rufu Chen, Dewei Li, Heguang Huang, Yi Miao, Yahui Liu, Tingbo Liang, Wei Wang, Jingxiong Yuan, Shizhen Li, Hang Zhang, Min Wang, Renyi Qin
Journal: International Journal of Surgery (2023)

Background: Textbook outcome (TO) is a composite outcome measure for surgical quality assessment. The aim of this study was to assess TO following laparoscopic pancreaticoduodenectomy (LPD), identify factors independently associated with achieving TO, and analyze hospital variations regarding the TO after case-mix adjustment. Methods: This multicenter cohort study retrospectively analyzed 1029 consecutive patients undergoing LPD at 16 high-volume pancreatic centers in China from January 2010 to August 2016. The percentage of patients achieving TO was calculated. Preoperative and intraoperative variables were compared between the TO and non-TO groups. Multivariate logistic regression was performed to identify factors independently associated with achieving TO. Hospital variations regarding the TO were analyzed by the observed/expected TO ratio after case-mix adjustment. Differences in expected TO rates between different types of hospitals were analyzed using the one-way analysis of variance test. Results: TO was achieved in 68.9% ( n =709) of 1029 patients undergoing LPD, ranging from 46.4 to 85.0% between different hospitals. Dilated pancreatic duct (&gt;3 mm) was associated with the increased probability of achieving TO [odds ratio (OR): 1.564; P =0.001], whereas advanced age (≥75 years) and concomitant cardiovascular disease were associated with a lower likelihood of achieving TO (OR: 0.545; P =0.037 and OR: 0.614; P =0.006, respectively). The observed/expected TO ratio varied from 0.62 to 1.22 after case-mix adjustment between different hospitals, but no significant hospital variations were observed. Hospital volume, the surgeon’s experience with open pancreaticoduodenectomy and minimally invasive surgery, and surpassing the LPD learning curve were significantly correlated with expected TO rates. Conclusion: TO was achieved by less than 70% of patients following LPD. Dilated pancreatic ducts, advanced age, and concomitant cardiovascular disease were independently associated with achieving TO. No significant hospital variations were observed after case-mix adjustment.
Engineering exosome-based biomimetic nanovehicles for wound healing
Authors: Alireza Joorabloo, Tianqing Liu
Journal: Journal of Controlled Release (2023)

Complexity and difficulties in wound management are pressing concerns that affect patients' quality of life and may result in tissue infection, necrosis, and loss of local and systemic functions. Hence, novel approaches to accelerate wound healing are being actively explored over the last decade. Exosomes as important mediators of intercellular communications are promising natural nanocarriers due to their biocompatibility, low immunogenicity, drug loading and targeting capacities, and innate stability. More importantly, exosomes are developed as a versatile pharmaceutical engineering platform for wound repair. This review provides an overview of the biological and physiological functions of exosomes derived from a variety of biological origins during wound healing phases, strategies for exosomal engineering, and therapeutic applications in skin regeneration.
Hypoxia Potentiates the Inflammatory Fibroblast Phenotype Promoted by Pancreatic Cancer Cell–Derived Cytokines
Authors: Simon Schwörer, Francesco V. Cimino, Manon Ros, Kaloyan M. Tsanov, Charles Ng, Scott W. Lowe, Carlos Carmona-Fontaine, Craig B. Thompson
Journal: Cancer Research (2023)

Abstract Cancer-associated fibroblasts (CAF) are a major cell type in the stroma of solid tumors and can exert both tumor-promoting and tumor-restraining functions. CAF heterogeneity is frequently observed in pancreatic ductal adenocarcinoma (PDAC), a tumor characterized by a dense and hypoxic stroma that features myofibroblastic CAFs (myCAF) and inflammatory CAFs (iCAF) that are thought to have opposing roles in tumor progression. While CAF heterogeneity can be driven in part by tumor cell–produced cytokines, other determinants shaping CAF identity and function are largely unknown. In vivo, we found that iCAFs displayed a hypoxic gene expression and biochemical profile and were enriched in hypoxic regions of PDAC tumors, while myCAFs were excluded from these regions. Hypoxia led fibroblasts to acquire an inflammatory gene expression signature and synergized with cancer cell–derived cytokines to promote an iCAF phenotype in a HIF1α-dependent fashion. Furthermore, HIF1α stabilization was sufficient to induce an iCAF phenotype in stromal cells introduced into PDAC organoid cocultures and to promote PDAC tumor growth. These findings indicate hypoxia-induced HIF1α as a regulator of CAF heterogeneity and promoter of tumor progression in PDAC. Significance: Hypoxia in the tumor microenvironment of pancreatic cancer potentiates the cytokine-induced inflammatory CAF phenotype and promotes tumor growth. See related commentary by Fuentes and Taniguchi, p. 1560
Comparative analysis of prevalence, evaluation, management, and rehabilitation outcome of spontaneous isolated visceral artery dissection: a systematic review and meta-analysis of 80 reports
Authors: Yan Shi, Jiangzhou Guo, Jige Dong, Xueli Chen, Lihua Luo, Yan Shen
Journal: International Journal of Surgery (2023)

Background: Because of relatively little data for management and evaluation surrounding spontaneous isolated visceral artery dissection (IVAD), existing studies have failed to provide comprehensive analysis for the management, evaluation, prevalence, as well as natural course of the disease. Therefore, we collected and analyzed current evidence on spontaneous IVAD with the aim of providing quantitative pooled data for the natural course and treatment standardization of the disease. Methods: A systematic search of PubMed, Embase, the Cochrane Library, and Web of Science up to 1 June 2022, was conducted for relevant studies that investigating the natural course, treatment, classification, and outcomes of IVAD. The primary outcomes were to determine the difference in prevalence, risk factors, and characteristics between different spontaneous IVAD. Two reviewers assessed the trial quality and extracted the data independently. All statistical analyses were performed using the standard statistical procedures provided in Review Manager 5.2 and Stata 12.0. Results: A total of 80 reports with 1040 patients were identified. The pooled results indicated that in IVAD, isolated superior mesenteric artery dissection (ISMAD) was more prevalent, with a pooled prevalence of 60% (95% CI: 50–71%), followed by isolated celiac artery dissection (ICAD) (prevalence: 37%; 95% CI: 27–46%). IVAD was male predominated with a pooled proportion of 80% (95% CI: 72–89%). Similar results were found in ICAD (prevalence: 73%; 95% CI: 52–93%). More IVAD patients were diagnosed with symptoms than ICAD (64 vs. 59%). Regarding to the risk factors, this pooled analysis found smoking and hypertension were the top two conditions in both spontaneous IVAD and ICAD patients, with proportion of 43, 41, 44, and 32%, respectively. It was observed that ICAD appeared shorter dissection length (mean difference: −3.4 cm; 95% CI: −4.9 to −2.0; P &lt;0.0001), higher prevalence of Sakamoto’s classification Π (odds ratio: 5.31; 95% CI: 1.77−15.95; P= 0.003) and late progression (odds ratio: 2.84; 95% CI: 1.02−7.87; P= 0.05) than ISAMD. Conclusions: Spontaneous IVAD was male predominant and ISMAD was most prevalent followed by ICAD. Smoking and hypertension were the top two conditions in both spontaneous IVAD and ICAD patients. The majority of patients diagnosed with IVAD received observation and conservative treatment and experienced a low proportion of reintervention or progression, especially for ICAD patients. In addition, ICAD and ISMAD had several differences in clinical features and dissection characteristics. Future studies with enough sample size and long follow-up are required to clear the management, long-term outcome, and risk factors of the IVAD prognosis.
Association of Participation in a Value-Based Insurance Design Program With Health Care Spending and Utilization
Authors: Hui Zhang, David W. Cowling
Journal: JAMA Network Open (2023)

Importance Value-based insurance design (VBID) has mostly been used in improving medication use and adherence for certain conditions or patients, but its outcomes remain uncertain when applied to other services and to all health plan enrollees. Objective To determine the association of participation in a California Public Employees’ Retirement System (CalPERS) VBID program with its enrollees’ health care spending and utilization. Design, Setting, and Participants A retrospective cohort study with difference-in-differences propensity-weighted 2-part regression models was performed in 2021 to 2022. A VBID cohort was compared with a non-VBID cohort both before and after VBID implementation in California in 2019 with 2 years’ follow-up. The study sample included CalPERS preferred provider organization continuous enrollees from 2017 through 2020. Data were analyzed from September 2021 to August 2022. Exposures The key VBID interventions include (1) if selecting and using a primary care physician (PCP) for routine care, PCP office visit copayment is $10 (otherwise, PCP office visit copayment is $35 as for specialist visit); and (2) annual deductibles reduced by a half through completion of the following 5 activities: annual biometric screening, influenza vaccine, nonsmoking certification, second opinion for elective surgical procedures, and disease management participation. Main Outcomes and Measures The primary outcome measures included annual per member total approved payments for multiple inpatient and outpatient services. Results The 2 compared cohorts of 94 127 participants (48 770 were female [52%]; 47 390 were younger than 45 years old [50%]) had insignificant baseline differences after propensity-weighting adjustment. The VBID cohort had significantly lower probabilities of inpatient admissions (adjusted relative odds ratio [OR], 0.82; 95% CI, 0.71-0.95), and higher probabilities of receiving immunizations (adjusted relative OR, 1.07; 95% CI, 1.01-1.21) in 2019. Among those with positive payments, VBID was associated with higher mean total allowed amounts for PCP visits in 2019 and 2020 (adjusted relative payments ratio, 1.05; 95% CI, 1.02-1.08). There were no significant differences for inpatient and outpatient combined totals in 2019 and 2020. Conclusions and Relevance The CalPERS VBID program achieved desired goals for some interventions with no added total costs in its first 2 years of operation. VBID may be used to promote valued services while containing costs for all enrollees.
Autonomic and respiratory consequences of altered chemoreflex function: clinical and therapeutic implications in cardiovascular diseases
Authors: Alberto Giannoni, Chiara Borrelli, Francesco Gentile, Paolo Sciarrone, Jens Spießhöfer, Massimo Piepoli, George B. Richerson, John S. Floras, Andrew J.S. Coats, Shahrokh Javaheri, Michele Emdin, Claudio Passino
Journal: European Journal of Heart Failure (2023)
An Engineered Probiotic Platform for Cancer Epitope‐Independent Targeted Radionuclide Therapy of Solid Tumors
Authors: Nabil A. Siddiqui, Alec J. Ventrola, Alexandra R. Hartman, Tohonne Konare, Nitin S. Kamble, Shindu C. Thomas, Tushar Madaan, Jordan Kharofa, Mathieu G. Sertorio, Nalinikanth Kotagiri
Journal: Advanced Healthcare Materials (2023)

Targeted radionuclide therapy (TRT) is an emerging therapeutic modality for the treatment of various solid cancers. Current approaches rely on the presence of cancer-specific epitopes and receptors against which a radiolabeled ligand is systemically administered to specifically deliver cytotoxic doses of α and β particles to tumors. In this proof-of-concept study, tumor-colonizing Escherichia coli Nissle 1917 (EcN) is utilized to deliver a bacteria-specific radiopharmaceutical to solid tumors in a cancer-epitope independent manner. In this microbe-based pretargeted approach, the siderophore-mediated metal uptake pathway is leveraged to selectively concentrate copper radioisotopes,
Meningeal Mechanisms and the Migraine Connection
Authors: Dan Levy, Michael A. Moskowitz
Journal: Annual Review of Neuroscience (2023)

Migraine is a complex neurovascular pain disorder linked to the meninges, a border tissue innervated by neuropeptide-containing primary afferent fibers chiefly from the trigeminal nerve. Electrical or mechanical stimulation of this nerve surrounding large blood vessels evokes headache patterns as in migraine, and the brain, blood, and meninges are likely sources of headache triggers. Cerebrospinal fluid may play a significant role in migraine by transferring signals released from the brain to overlying pain-sensitive meningeal tissues, including dura mater. Interactions between trigeminal afferents, neuropeptides, and adjacent meningeal cells and tissues cause neurogenic inflammation, a critical target for current prophylactic and abortive migraine therapies. Here we review the importance of the cranial meninges to migraine headaches, explore the properties of trigeminal meningeal afferents, and briefly review emerging concepts, such as meningeal neuroimmune interactions, that may one day prove therapeutically relevant.
Effectiveness of Molnupiravir and Nirmatrelvir–Ritonavir in Hospitalized Patients With COVID-19
Authors: Eric Yuk Fai Wan, Vincent Ka Chun Yan, Anna Hoi Ying Mok, Boyuan Wang, Wanchun Xu, Franco Wing Tak Cheng, Francisco Tsz Tsun Lai, Celine Sze Ling Chui, Xue Li, Carlos King Ho Wong, Philip Hei Li, Benjamin John Cowling, Ivan Fan Ngai Hung, Chak Sing Lau, Ian Chi Kei Wong, Esther Wai Yin Chan
Journal: Annals of Internal Medicine (2023)

Whether hospitalized patients benefit from COVID-19 oral antivirals is uncertain.